Autonomy In Healthcare Decision-making Research Articles

Using artificial intelligence to enhance patient autonomy in healthcare decision-making

Using artificial intelligence to enhance patient autonomy in healthcare decision-making

Maternal Healthcare Services Utilisation and Its Associated Risk Factors: A Pooled Study of 37 Low- and Middle-Income Countries.

Objectives: The utilisation of maternal healthcare services (MHS) can play an essential role in reducing maternal deaths. Thus, this study examines the prevalence and factors associated with MHS utilisation in 37 low-and-middle-income countries (LMICs). Methods: A total of 264,123 women were obtained from the Demographic and Health Surveys of 37 LMICs. Multivariate logistic regression was performed to identify the factors associated with maternal healthcare services utilisation. Results: Around one-third (33.7%) of the respondents properly utilise MHS among women of childbearing age. In the pooled sample, the odds of MHS utilisation were significantly higher with the increase in wealth index, women's age, age at the first birth, and husband/partner's education. Urban residence (AOR [adjusted odds ratio] = 1.56; 95% CI [confidence interval]: 1.49-1.64), women's autonomy in healthcare decision-making (AOR = 1.19; 95% CI: 1.15-1.24) and media exposure (AOR = 1.70; 95% CI: 1.58-1.83) were found to be the strongest positive factors associated with utilisation of MHS. In contrast, larger family (AOR = 0.93; 95% CI: 0.91-0.96), and families with 7 or more children (AOR = 0.72; 95% CI: 0.68-0.77) were significantly negatively associated with MHS utilisation. Conclusion: The utilisation of MHS highly varied in LMICs and the associated factors. Expanding the wealth status, education, age at first birth, mothers' autonomy in healthcare decisions, and media exposure could be essential strategies for increasing the utilisation of MHS; however, country-specific programs should be considered in national policy discussions. There is a need to formulate policies and design maternal health services programs that target socially marginalised women.

Exploring Factors Influencing Paternal Engagement in Prenatal Health Services within Hoima East Division, Hoima City: A Comprehensive Assessment

Socioeconomic, cultural, and gender dynamics continue to impede women's autonomy in healthcare decision-making. Men often wield control over financial resources, time allocation, and access to medical services, creating disparities in women's health choices. This study investigated male engagement in antenatal care among residents of Hoima East Division, Hoima City in Western Uganda. Employing a cross-sectional survey design and quantitative methods, data was meticulously coded, cleaned, and analyzed using Microsoft Excel Version 13 and STATA 14.0. The study encompassed 534 participants, with a predominant age range of 21-30 years (59.4%) and a majority being married (82.2%). Most participants had completed secondary education (53.8%), identified as Catholic (41.1%), and had 3-4 children (50.1%). Results indicated that 263 individuals (69.8%) exhibited low levels of male involvement in antenatal care, while 114 (30.2%) demonstrated high levels of engagement. Notably, 54.6% displayed inadequate knowledge, contrasting with the 45.4% who exhibited a strong grasp of antenatal care. The analysis revealed significant associations between male involvement and various factors including age, marital status, educational attainment, employment status, decision-making capacity, monthly income, perception of healthcare providers' attitudes, privacy provisions at antenatal clinics, and waiting times. Despite these findings, the level of male involvement and understanding of antenatal care remained suboptimal. In summary, this research highlights the multifaceted interplay of factors influencing male involvement in antenatal care. Factors such as age, marital status, education, employment, decision-making capacity, income, healthcare provider attitudes, and clinic conditions emerged as pivotal determinants. Addressing these variables can potentially enhance male participation and knowledge regarding antenatal care, ultimately empowering women in making informed health decisions. Keywords: Antenatal care and associated factors, Attitude of health care providers, Health facilities, Maternity care, Male partners.

Married women decision making autonomy on health care utilization in high fertility sub-Saharan African countries: A multilevel analysis of recent Demographic and Health Survey.

Women's decision-making autonomy has a potential impact on the scale-up of health care utilization. In high fertility countries, evidence regarding women's decision-making autonomy on their health care utilization and its associated factors is limited and inconclusive. Hence, it is important to investigate women decision-making autonomy on their health care utilization and associated factors in high fertility countries in sub-Saharan Africa. The data source for this study was obtained from recent Demographic and Health Surveys that were comprised of a weighted sample of 178875 reproductive age women. A multilevel mixed-effect binary logistic regression model was fitted. The odds ratios, along with the 95% confidence interval were generated to identify individual and community-level factors associated with women's autonomy in health care decision-making. A p-value less than 0.05 was declared as statistical significance. In this study, 42% (95% CI: 41.7, 42.3) of women were able to exercise their reproductive autonomy. The highest (74.8%) and the lowest (19.74%) magnitude of women autonomy was found in Angola and Mali, respectively. In multilevel analysis; age of women 25-34 years, 35 and above (AOR = 1.34, 95% CI: 1.29, 1.39), and (AOR = 1.78, 95% CI: 1.75, 1.90), women's primary and secondary educational level (AOR = 1.25, 95% CI: 1.20, 1.31), and (AOR = 1.44, 95% CI: 1.32, 1.54), husband primary and secondary educational level (AOR = 1.24, 95% CI: 1.18, 1.29), and (AOR = 1.21, 95% CI: 1.15, 1.27), women who had work (AOR = 1.67, 95% CI: 1.59, 1.74) female household heads (AOR = 1.44, 95% CI: 1.37, 1.51), media exposure (AOR = 1.04, 95% CI: 1.09, 1.18), health insurance coverage (AOR = 1.26, 95% CI: 1.17, 1.36), urban residence (AOR = 1.14, 95% CI: 1.09, 1.19), community education (AOR = 2.43, 95% CI: 2.07, 2.85) and low community poverty level (AOR = 1.27, 95% CI: 1.08, 1.49) were predictor variables. Although every woman has the right to make her own health care decisions, this study showed that almost 58% of them had no role in making decisions about their health care utilization. Thus, each country Government should support women's decision making autonomy regarding their healthcare utilization through mass media and extensive behavioral education.

Individual and community level predictors of women’s autonomy in health care decision-making among youth in East African countries: a multilevel analysis

ObjectiveThe autonomy of young women in healthcare decision-making has been reported to be lower, particularly in low-income and middle-income countries. This study was conducted to estimate the magnitude and the...

Women’s autonomy and its effect on antenatal care visits among Tharu women of reproductive age (15-49) of Khairahani Municipality, Nepal

Women's autonomy in health care decision-making is enormously essential for improved maternal and child health outcomes and women's empowerment. This study examines women's autonomy and its effect on antenatal care (ANC) visits among the women of the Tharu community of Khairahani municipality, Chitwan. The probability proportional to size (PPS) sampling technique was adapted for sample estimation in each selected ward. A list of all the Tharu households in the community was prepared from which 294 women were selected using systematic random sampling techniques. Univariate, bivariate (Chisquare test), and multivariate analyses (binary logistic regression) were performed. One-fifth of women were youths aged 15-24 (mean 27.8 years). One out of ten women was illiterate, and about two-thirds (65%) were involved in agriculture. More than two in five women (42%) did not have autonomy. Women's autonomy, age group, educational status, occupational status, and husband's occupational status were significantly associated with antenatal care visits. A significantly high number of women (p<0.001) who had high autonomy (89%), compared with those who had no autonomy (65%), used ANC services for their last birth. Women with low autonomy and high autonomy were three times (OR=3.05; 95% CI=1.01-8.5) and 4.5 times (OR=4.5; 95% CI 2.3-8.6) more likely to utilize ANC visits than those who had no autonomy. Women's autonomy in healthcare decision-making, household purchases, and money expenditure were significantly associated with the use of antenatal care visits. Women's participation in the decision-making process regarding health care and household matters should be focused on and increased for better utilization of antenatal care services.

The older person’s experience of autonomy in healthcare decision-making in Ireland: The relationship between law, policy, and practice

The law on healthcare decision-making in Ireland is in a period of transition and will be enhanced with the full commencement of the Assisted Decision-Making (Capacity) Act (ADMC Act) 2015. The legislation is intended to empower a person to make decisions relating to their healthcare and personal affairs where they lack or may in the future lack the capacity to make their own decisions. This is especially relevant for the older person in terms of planning for future healthcare decisions. This article reports on quantitative and qualitative research which examined the exercise of autonomy by the older person in Ireland in the context of healthcare decision-making. The research compared the lived experience of healthcare decision-making with the existing legal and policy framework. The research sought to identify what is currently understood about the ADMC Act and awareness of the changes it will bring about in decision-making for the older person. These data assist in identifying strengths, such as a feeling of involvement, and weaknesses, such as an asymmetry of information, in the operation of the current decision-making framework while also identifying potential hurdles to the meaningful implementation of the 2015 Act.

Why do women attend antenatal care but give birth at home? a qualitative study in a rural Ghanaian District.

The Sustainable Development Goal Three has prioritised reducing maternal, under-5 and neonatal mortalities as core global health policy objectives. The place, where expectant mothers choose to deliver their babies has a direct effect on maternal health outcomes. In sub-Saharan Africa, existing literature has shown that some women attend antenatal care during pregnancy but choose to deliver their babies at home. Using the Andersen and Newman Behavioural Model, this study explored the institutional and socio-cultural factors motivating women to deliver at home after attending antenatal care. A qualitative, exploratory, cross-sectional design was deployed. Data were collected from a purposive sample of 23 women, who attended antenatal care during pregnancy but delivered their babies at home, 10 health workers and 17 other community-level stakeholders. The data were collected through semi-structured interviews, which were audio-recorded, transcribed and thematically analysed. In line with the Andersen and Newman Model, the study discovered that traditional and religious belief systems about marital fidelity and the role of the gods in childbirth, myths about consequences of facility-based delivery, illiteracy, and weak women's autonomy in healthcare decision-making, predisposed women to home delivery. Home delivery was also enabled by inadequate midwives at health facilities, the unfriendly attitude of health workers, hidden charges for facility-based delivery, and long distances to healthcare facilities. The fear of caesarean section, also created the need for women who attended antenatal care to deliver at home. The study has established that socio-cultural and institutional level factors influenced women's decisions to deliver at home. We recommend a general improvement in the service delivery capacity of health facilities, and the implementation of collaborative educational and women empowerment programmes by stakeholders, to strengthen women's autonomy and reshape existing traditional and religious beliefs facilitating home delivery.

Continuity of maternal healthcare services utilisation in Indonesia: analysis of determinants from the Indonesia Demographic and Health Survey

ObjectiveWHO recommends that every pregnant woman and newborn receive quality care throughout the pregnancy, delivery and postnatal periods. However, Maternal Mortality Ratio in Indonesia for 2015 reached 305 per 100...

The trends of women\u2019s autonomy in health care decision making and associated factors in Ethiopia: evidence from 2005, 2011 and 2016 DHS data

BackgroundWomen's autonomy in health care decision-making is very crucial for the well-being of women themselves, their children, and the entire family members. Although studying the issue is significant to take proper interventions, the issue is not studied at a nationwide level in Ethiopia. Accordingly, this population-based nationwide study was aimed at assessing the trends of women’s autonomy in health care decision-making and its associated factors in Ethiopia.MethodThe sample was limited to married women of 2005 (n = 8617), 2011 (n = 10,168), and 2016 (n = 9824) Ethiopian Demographic and Health Survey (EDHS) data. Women's autonomy in health care decision-making was measured based on their response to the question ‘person who usually decides on respondent's health care. To examine associated factors, socio-demographic variables were computed using multinomial logistic regression.ResultThe finding revealed that the trend of women’s autonomy in health care decision-making had declined from 18.7% in 2005 to 17.2% in 2011 albeit it had risen to 19.1% in 2016. The autonomy of women who resides in urban areas was 98.7% higher than rural residents, and those who live in the Tigray region, Somali region, and Addis Ababa are 76.6%, 79.7%, and 95.7% higher than who live in Dire Dawa respectively. Unemployed women, women aged from 15 to 24 years, and uneducated women were 45.1%, 32.4%, and 32.2% less likely autonomous in health care decision making respectively.ConclusionThe autonomy of women in health care decision-making had declined from 2005 to 2011. Therefore, the role of stakeholders in taking possible interventions like empowering women shall be strengthened. This is to protect women from certain health problems as well as for the well-being of women themselves, their children, and the entire family members.

Spatial clusters distribution and modelling of health care autonomy among reproductive\u2010age women in Ethiopia: spatial and mixed\u2010effect logistic regression analysis

BackgroundWhile millions of women in many African countries have little autonomy in health care decision-making, in most low and middle-income countries, including Ethiopia, it has been poorly studied. Hence, it is important to have evidence on the factors associated with women’s health care decision making autonomy and the spatial distribution across the country. Therefore, this study aimed to investigate the spatial clusters distribution and modelling of health care autonomy among reproductive-age women in Ethiopia.MethodsWe used the 2016 Ethiopian Demographic and Health Survey (EDHS) data for this study. The data were weighted for design and representativeness using strata, weighting variable, and primary sampling unit to get a reliable estimate. A total weighted sample of 10,223 married reproductive-age women were included in this study. For the spatial analysis, Arc-GIS version 10.6 was used to explore the spatial distribution of women health care decision making and spatial scan statistical analysis to identify hotspot areas. Considering the hierarchical nature of EDHS data, a generalized linear mixed-effect model (mixed-effect logistic regression) was fitted to identify significant determinants of women’s health care decision making autonomy. The Intra-Class Correlation (ICC) were estimated in the null model to estimate the clustering effect. For model comparison, deviance (-2LLR), Akakie Information Criteria (AIC), and Bayesian Information Criteria (BIC) parameters were used to choose the best-fitted model. Variables with a p-value < 0.2 in the bivariable analysis were considered for the multivariable analysis. In the multivariable mixed-effect logistic regression analysis, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were reported to declare the strength and significance of the association between women’s decision-making autonomy and independent variables.ResultsIn this study, about 81.6% (95% CI: 80.6%, 82.2%) of women have autonomy in making health care decisions. The spatial distribution of women’s autonomy in making health decisions in Ethiopia was non-random (global Moran’s I = 0.0675, p < 0.001). The significant hotspot areas of poor women’s autonomy in making health care decisions were found in north Somali, Afar, south Oromia, southwest Somali, Harari, and east Southern Nations Nationalities and Peoples (SNNP) regions. In the mixed-effect logistic regression analysis; being urban (AOR = 1.59, 95% CI: 1.04, 2.45), having secondary education (AOR = 1.60, 95% CI: 1.06, 2.41), having an occupation (AOR = 1.19, 95% CI: 1.01, 1.40) and being from the richest household (AOR = 2.14, 95% CI: 1.45, 3.14) were significantly associated with women autonomy in deciding for health care.ConclusionsThe spatial distribution of women’s autonomy in making the decision for health care was non-random in Ethiopia. Maternal education, residence, household wealth status, region, and maternal occupation were found to influence women’s autonomy. Public health interventions targeting the hotspot areas of poor women autonomy through enhancing maternal occupation and employment is needed to improve women empowerment in making decisions for health care.

Women's autonomy in healthcare decision-making and healthcare seeking behaviour for childhood illness in Ghana: Analysis of data from the 2014 Ghana Demographic and Health Survey.

The capacity of women to decide on their healthcare plays a key role in their health. In this study, we examined the association between women's healthcare decision-making capacity and their healthcare seeking behaviour for childhood illnesses in Ghana. We used data from the 2014 Ghana Demographic and Health Survey. A total sample of 2,900 women with children less than 5 years was used for the analysis. Data were processed and analysed using STATA version 14.0. Chi-square test of independence and binary logistic regression were carried out to generate the results. Statistical significance was pegged at 95% confidence intervals (CIs). We relied on the 'Strengthening the Reporting of Observational Studies in Epidemiology' (STROBE) statement in writing the manuscript. Out of the 2,900 women, approximately 25.7% could take healthcare decisions alone and 89.7% sought healthcare for childhood illnesses. Women who decided alone on personal healthcare had 30% reduced odds of seeking healthcare for childhood illnesses compared to those who did not decide alone [AOR = 0.70, CI = 0.51-0.97]. With age, women aged 45-49 had 69% reduced odds of seeking healthcare for childhood illnesses compared to those aged 25-29 [AOR = 0.31, CI = 0.14-0.70]. Women from the Northern and Upper West regions had 72% [AOR: 0.28, CI: 0.11-0.70] and 77% [AOR: 0.23, CI: 0.09-0.58] reduced odds of seeking healthcare for childhood illnesses respectively, compared to those from the Western region. Ghanaian women with autonomy in healthcare decision-making, those who were older and those from the Northern and Upper West regions were less likely to seek healthcare for childhood illness. To reduce childhood mortalities and morbidities in Ghana, we recommend educating women such as those who take healthcare decisions alone, older women and women from deprived regions like the Northern and Upper West regions on the need to seek healthcare for childhood illnesses.

Impaired Quality of Life and Its Determinants among Postmenopausal Women of Slum Communities in Bhubaneswar, India.

Background:The severity of menopausal symptoms negatively impacts a woman's quality of life (QoL).Objective:The aim of the study was to assess the prevalence of menopause-related impaired QoL and determine its associated factors among postmenopausal women living in slum areas of Bhubaneswar, India.Materials and Methods:This cross-sectional study was conducted among 198 postmenopausal women aged 45–65 years during the year 2016–2017. The Menopause Rating Scale (MRS) was used to assess the prevalence and severity of menopausal symptoms.Results:Joint and muscular discomfort was the most prevalent moderate-to-severe symptom (90.4%), followed by hot flushes (72.8%), irritability (67.2%), and physical and mental exhaustion (64.2%). More than two-third (133, 67.2%) of women had impaired QoL (severe total MRS score ≥17). Multivariate logistic regression analysis revealed that impaired QoL was associated younger age (adjusted odds ratio [AOR]: 4.6, 95% confidence interval [CI]: 2.12–9.98), tobacco consumption (AOR: 2.0, 95% CI: 1.05–3.82), not being satisfied in relation with husband (AOR: 3.33, 95% CI: 1.84–6.06), not having autonomy in health-care decision-making in the family (AOR: 2.30, 95% CI: 1.12–4.73), history of reproductive tract infection (AOR: 4.57, 95% CI: 1.71–12.19), and earlier onset of menopause (AOR: 3.26, 95% CI: 1.18–8.96).Conclusion:The point prevalence of menopause-related impaired QOL in postmenopausal women living in slums of Bhubaneswar was high. Incorporating these determinants in the existing strategies can be useful to improve the QoL of these women.

Development of a tailored, telehealth intervention to address chronic pain and heavy drinking among people with HIV infection: integrating perspectives of patients in HIV care

BackgroundChronic pain and heavy drinking commonly co-occur and can influence the course of HIV. There have been no interventions designed to address both of these conditions among people living with HIV (PLWH), and none that have used telehealth methods. The purpose of this study was to better understand pain symptoms, patterns of alcohol use, treatment experiences, and technology use among PLWH in order to tailor a telehealth intervention that addresses these conditions.SubjectsTen participants with moderate or greater chronic pain and heavy drinking were recruited from a cohort of patients engaged in HIV-care (Boston Alcohol Research Collaborative on HIV/AIDS Cohort) and from an integrated HIV/primary care clinic at a large urban hospital.MethodsOne-on-one interviews were conducted with participants to understand experiences and treatment of HIV, chronic pain, and alcohol use. Participants’ perceptions of the influence of alcohol on HIV and chronic pain were explored as was motivation to change drinking. Technology use and treatment preferences were examined in the final section of the interview. Interviews were recorded, transcribed and uploaded into NVivo® v12 software for analysis. A codebook was developed based on interviews followed by thematic analysis in which specific meanings were assigned to codes. Interviews were supplemented with Likert-response items to evaluate components of the proposed intervention.ResultsA number of themes were identified that had implications for intervention tailoring including: resilience in coping with HIV; autonomy in health care decision-making; coping with pain, stress, and emotion; understanding treatment rationale; depression and social withdrawal; motives to drink and refrain from drinking; technology use and capacity; and preference for intervention structure and style. Ratings of intervention components indicated that participants viewed each of the proposed intervention content areas as “helpful” to “very helpful”. Videoconferencing was viewed as an acceptable modality for intervention delivery.ConclusionsResults helped specify treatment targets and provided information about how to enhance intervention delivery. The interviews supported the view that videoconferencing is an acceptable telehealth method of addressing chronic pain and heavy drinking among PLWH.

Dementia, Autonomy, and Supported Healthcare Decision Making

Healthcare providers often rely on surrogates to decide on behalf of their patients with dementia who are deemed incapable of exercising autonomy. There is a longstanding debate about the appropriate standard of surrogate healthcare decisionmaking for these patients. Many influential scholars argue that the precedent autonomy of the person with dementia should be respected, and healthcare decision-making laws generally reflect this principle. These laws direct surrogate decisionmakers to follow instructions in living wills or to decide on the basis of the wishes and values of the person before the onset of dementia. But other prominent scholars have questioned whether surrogates should instead use the best interests standard, which accounts for the current interests of the person with dementia. This debate about decision-making standards ignores an arguably more important issue: who should be deciding? Empirical research demonstrates that persons with mild dementia retain the ability to make or participate in decisions despite their acquired cognitive impairments, and that they prefer to be actively involved in healthcare decisionmaking. However, persons with dementia are routinely marginalized in the decision-making process, which leads to a decline in their psychological wellbeing. Based on studies of their decision-making abilities, preferences, and experiences, this Article will argue that persons with dementia should not be prevented from making their own healthcare decisions. Stated differently, persons with dementia should have the legal right to make their own healthcare decisions at the time when the decisions need to be made. Ensuring this right will require looking beyond surrogate-based healthcare decision-making law, which facilitates the exclusion of persons with dementia from decisionmaking. Disability law in six U.S. jurisdictions provides an alternative decision-making model, known as supported decisionmaking, which empowers persons with cognitive impairments to make their own decisions and could be usefully applied to dementia. In supported decisionmaking, an adult with a disability (the “principal”) voluntarily chooses people to assist them in decisionmaking (a “supporter”) and formalizes this arrangement in a written agreement. The supporter’s role is to help the principal gather relevant information, think through the decision, and convey the decision to other people. Supported decisionmaking preserves the legal decision-making authority of a person with a disability rather than transferring such authority to a surrogate. Because supported decisionmaking accords with the preferences and interests of persons with dementia, supported decision-making laws should be widely adopted. This novel application of supported decisionmaking to dementia also provides insight into the nature of autonomy in the larger context of late-life healthcare decisionmaking. My past research has demonstrated that autonomous decisionmaking in this context is relational, which is consistent with supported decisionmaking. This Article will further build upon this conceptualization and advance a new understanding of autonomy in healthcare decisionmaking as more closely approximating relational agency. With this revised understanding of autonomy and the adoption of supported decisionmaking, persons with dementia can remain autonomous for longer in the progression of their disease.

Socioeconomic factors associated with full childhood vaccination in Bangladesh, 2014

ObjectivesChildhood vaccination in Bangladesh has improved, but there is room for improvement. This study estimated full immunization coverage in Bangladeshi children and characterized risk factors for incomplete immunization. MethodsUsing the 2014 Bangladesh Demographic and Health Survey (DHS), full vaccination of children aged 12 to 24 months was examined; this was defined as the receipt of one dose of bacillus Calmette–Guérin (BCG), three doses of pentavalent vaccine, three doses of oral polio vaccine (OPV), and one dose of measles-containing vaccine (MCV). Associations between full vaccination and selected risk factors were assessed by logistic regression. ResultsOverall, 83% of children were fully vaccinated. BCG had the highest completion (97%), followed by OPV (92%), pentavalent vaccine (91%), and MCV (85%). Full vaccination coverage ranged from 64.4% in Sylhet to 90.0% in Rangpur and was lowest among non-locals of all regions (78.4%). Children who were in the lowest wealth quintile, who had mothers without antenatal care visits, or who had mothers without autonomy in healthcare decision-making were less likely to be fully vaccinated. ConclusionsOverall, full vaccination of children is high, but varies by vaccine type. Disparities still exist by wealth and by region. Maternal access to care and autonomy in healthcare decision-making are associated with higher vaccination coverage.

Progress in the utilization of antenatal and delivery care services in Bangladesh: where does the equity gap lie?

BackgroundUniversal access to health care services does not automatically guarantee equity in the health system. In the post Millennium Development Goals (MDGs) era, the progress towards universal access to maternal health care services in a developing country, like Bangladesh requires an evaluation in terms of equity lens. This study, therefore, analysed the trend in inequity and identified the equity gap in the utilization of antenatal care (ANC) and delivery care services in Bangladesh between 2004 and 2011.MethodsThe data of this study came from the Bangladesh Demographic and Health Survey. We employed rate ratio, concentration curve and concentration index to examine the trend in inequity of ANC and delivery care services. We also used logistic regression models to analyse the relationship between socioeconomic factors and maternal health care services.ResultsThe concentration index for 4+ ANC visits dropped from 0.42 in 2004 to 0.31 in 2011 with a greater decline in urban area. There was almost no change in the concentration index for ANC services from medically trained providers during this period. We also found a decreasing trend in inequity in the utilization of both health facility delivery and skilled birth assistance but this trend was again more pronounced in urban area compared to rural area. The concentration index for C-section delivery decreased by about 33 % over 2004–2011 with a similar rate in both urban and rural areas. Women from the richest households were about 3 times more likely to have 4+ ANC visits, delivery at a health facility and skilled birth assistance compared to women from the poorest households. Women’s and their husbands’ education were significantly associated with greater use of maternal health care services. In addition, women’s exposure to mass media, their involvement in microcredit programs and autonomy in healthcare decision-making appeared as significant predictors of using some of these health care services.ConclusionsBangladesh faces not only a persistent pro-rich inequity but also a significant rural-urban equity gap in the uptake of maternal health care services. An equity perspective in policy interventions is much needed to ensure safe motherhood and childbirth in Bangladesh.

Women's autonomy in health care decision-making in developing countries: a synthesis of the literature.

Autonomy is considered essential for decision-making in a range of health care situations, from health care seeking and utilization to choosing among treatment options. Evidence suggests that women in developing or low-income countries often have limited autonomy and control over their health decisions. A review of the published empirical literature to identify definitions and methods used to measure women’s autonomy in developing countries describe the relationship between women’s autonomy and their health care decision-making, and identify sociodemographic factors that influence women’s autonomy and decision-making regarding health care was carried out. An integrated literature review using two databases (PubMed and Scopus) was performed. Inclusion criteria were 1) publication in English; 2) original articles; 3) investigations on women’s decision-making autonomy for health and health care utilization; and 4) developing country context. Seventeen articles met inclusion criteria, including eleven from South Asia, five from Africa, and one from Central Asia. Most studies used a definition of autonomy that included independence for women to make their own choices and decisions. Study methods differed in that many used study-specific measures, while others used a set of standardized questions from their countries’ national health surveys. Most studies examined women’s autonomy in the context of reproductive health, while neglecting other types of health care utilized by women. Several studies found that factors, including age, education, and income, affect women’s health care decision-making autonomy. Gaps in existing literature regarding women’s autonomy and health care utilization include gaps in the areas of health care that have been measured, the influence of sex roles and social support, and the use of qualitative studies to provide context and nuance.

Married Women’s Autonomy and Associated Factors on Modern Contraceptive Use in Adwa Town, Northern Ethiopia

Background: Women’s autonomy of modern contraceptive use means that those women taking, not taking or even stopping using modern contraceptive by their own decision only. Women’s autonomy in health care decision-making is extremely important for better maternal and child health outcomes. Fertility and contraceptive use in developing countries are associated with various markers of socioeconomic status, most prominent of which is women's autonomy. Women in developing countries, including Ethiopia are either under collective decision making with their partners or completely rely on the male partner’s decision on issues that affect their contraceptive use. The objective of this study was to assess the prevalence of married women’s autonomy and associated factors for modern contraceptive use in Adwa town, Tigray Region, North Ethiopia. Methods: A community based cross-sectional study design was conducted from September 7-18, 2012. Three hundred seventy married women were selected using simple random sampling technique. Data were entered, cleaned and analyzed by using statistical package for social sciences (SPSS) Version 20.0 (SPSS Illinois, Chicago). Binary descriptive statistics and multiple variable regressions were done. Results: In this study from a total of 370 respondents, 133(35.9%) reported that they had autonomy on modern contraceptive use. Educational status of the women was a strong significant predictor in the women’s autonomy on modern contraceptive use. Moreover, mothers did not know their husband’s attitude towards contraception use (AOR=4.34,95% CI:1.54,12.2), discussed with their husband about the number of children (AOR=0.48,95% CI:0.24,0.96), born two and less children (AOR= 0.14, 95% CI: 0.03, 0.66) and decides their future number of children by themselves (AOR=34.8, 95% CI:12.14,99.7) and by joint decision (AOR=2.5,95% CI:1.04,6.0) were more likely autonomous on modern contraceptive use. Conclusions: The autonomy of married women on modern contraceptive use in this study was low. Having better educational attainment has an input on increase women's autonomy on modern contraceptive use. Women who had power of deciding on the number of child present, number child will have in the future, the number of children born and husband’s attitude toward contraceptive use could influence on autonomy of women on modern contraceptive use.

Autonomy and Mental Disorder

Article AbstractBecause this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text.Whether by intent or accident, each of us, upon making psychiatry our chosen specialty, steps into a philosophical minefield that we are generally unprepared to navigate. Even those psychiatrists who claim no expertise at addressing what constitutes "the good life" face big questions concerning free will and determinism, dualism and holism, virtue, vice, and victimhood. For several decades, medicine as a whole has wrestled with the ever higher premium placed on patient autonomy in health care decision-making.